Khalil Hanan I, Patterson Stacey A, Panicek David M
Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
Radiology. 2005 Jun;235(3):872-8. doi: 10.1148/radiol.2353041099. Epub 2005 Apr 15.
To retrospectively evaluate the prevalence and clinical importance of hepatic lesions considered too small to characterize (TSTC) at initial computed tomography (CT) in women with breast cancer.
Approval for this retrospective study was obtained from the institutional review board, which waived the requirement for informed consent. For each woman who received a diagnosis of breast cancer between 1998 and 2002, the authors reviewed the report of the first contrast material-enhanced CT examination that included assessment of the liver. For women with no definite liver metastasis and at least one hepatic lesion considered TSTC, reports of follow-up imaging examinations were reviewed for a change in lesion size; medical records and images were reviewed if there was a change in lesion size. The 95% confidence intervals (CIs) were calculated for best- and worst-case analyses of cases in which different assumptions were used to classify a lesion as benign.
Of 7692 women, 1012 (13.2%) underwent contrast-enhanced CT including liver assessment. The mean age of the 1012 women was 54.6 years (range, 20.7-89.1 years). The median time from diagnosis of breast cancer to initial CT examination was 14.1 weeks (range, -3.7 to 296 weeks). The presence of at least one hepatic lesion deemed TSTC was reported in 277 of 941 women (29.4%) in whom no definite hepatic metastasis was reported. Subsequent imaging examinations were performed in 191 of the 277 women (69.0%) (median time from initial CT to last follow-up imaging examination, 54 weeks; range, 0.3-302 weeks). Those examinations revealed the lesions were unchanged in 175 (91.6%) women, no longer visible in eight (4.2%), and larger in six (3.1%). In two women (1.0%), change could not be determined. The enlarging hepatic lesions deemed TSTC represented metastatic breast cancer (three patients), metastatic pancreatic cancer (one patient), or cysts (one patient); in one patient, the etiology was not known. Results of best- and worst-case analyses showed that the lesions were benign in 96.9% (95% CI: 93%, 99%) and 92.7% (95% CI: 88%, 96%) of women, respectively.
In 92.7%-96.9% of women with breast cancer and hepatic lesions deemed TSTC but no definite liver metastases at initial CT, the lesions represented a benign finding.
回顾性评估乳腺癌女性患者初次计算机断层扫描（CT）时肝脏内太小而无法定性（TSTC）的病变的患病率及临床重要性。
本回顾性研究获机构审查委员会批准，该委员会免除了知情同意的要求。对于1998年至2002年间确诊为乳腺癌的每位女性，作者查阅了首次对比剂增强CT检查报告，其中包括对肝脏的评估。对于无明确肝转移且至少有一个肝脏病变被视为TSTC的女性，查阅随访影像检查报告以了解病变大小的变化；若病变大小有变化，则查阅病历和影像资料。针对在不同假设下将病变分类为良性的病例，计算了95%置信区间（CI）用于最佳和最坏情况分析。
7692名女性中，1012名（13.2%）接受了包括肝脏评估的对比增强CT检查。这1012名女性的平均年龄为54.6岁（范围20.7 - 89.1岁）。从乳腺癌诊断到初次CT检查的中位时间为14.1周（范围 - 3.7至296周）。在941名未报告有明确肝转移的女性中，有277名（29.4%）报告至少有一个肝脏病变被视为TSTC。277名女性中的191名（69.0%）进行了后续影像检查（从初次CT到最后一次随访影像检查的中位时间为54周；范围0.3 - 302周）。这些检查显示，175名（91.6%）女性的病变无变化，8名（4.2%）女性的病变不再可见，6名（3.1%）女性的病变增大。两名女性（1.0%）的病变变化情况无法确定。增大的被视为TSTC的肝脏病变代表转移性乳腺癌（3例患者）、转移性胰腺癌（1例患者）或囊肿（1例患者）；1例患者的病因不明。最佳和最坏情况分析结果显示，分别有96.9%（95%CI：93%，99%）和92.7%（95%CI：88%·，96%）的女性病变为良性。
在初次CT时肝脏病变被视为TSTC但无明确肝转移的乳腺癌女性中，92.7% - 96.9%的病变为良性表现。
